Myofascial Injury, Fibromyalgia and Connective Tissue Disease

 

 

What is the Myofascial System?

The Myofascial System is made up of the body’s muscles, fascia, ligaments and tendons.  It is sometimes described as a single web-like structure that attaches muscles to the bones creating a body suit that runs from our toes to the top of our head.

 

What is the function of our Myofascial System?

The Myofascial System integrates the muscles and soft tissues with strong bonds as mentioned above so that our bodies can move multiple muscle groups as a unit.

 

How does a Myofascial condition develop?

In the normal state, the Myofascia is soft and flexible with a nice tone and can stretch and move without restriction.  However, when injured due to trauma such as a car accident or long-term repetitive movement, the fascia and muscle shortens causing dysfunction and pain in movement.  If predisposed conditions exist such as Fibromyalgia or a connective tissue disease, this could result in incapacitating pain.

 

What is Fibromyalgia?

Fibromyalgia is a condition commonly characterized by widespread body pain. People who suffer from this condition experience a heightened sensation to pressure.  The cause of Fibromyalgia is unknown and under considerable investigation in the environmental, neurologic, genetic and psychological arenas.  The most commonly accepted areas of study are neurologic and environmental since most people seem to develop the condition much later in life. Other symptoms correlate with Fibromyalgia such as fatigue, joint stiffness, trouble sleeping, difficulty swallowing, numbness, tingling, and cognitive dysfunction. These are actual neurologic changes in both the brain and the stem leading some to call it a ‘central sensitization syndrome.’

 

 

 

 

What is Connective Tissue Disease?

Connective tissue is an extensive extracellular matrix that binds together and supports all tissues of the body including organs.  Connective tissues diseases can be hereditary (Ehlers-Danlos, Marfan Syndrome and Osteogenesis Imperfecta) or autoimmune (Sjogren’s Syndrome, Rheumatoid Arthritis and Systemic Lupus Erythematous).  Many of these diseases can actually overlap or mimic each other making treatment and diagnosis very difficult.  Symptoms often include joint pain, fatigue, weakness, organ changes and sometimes hypermobility.

 

How do you choose a manual medicine specialist?

It is extremely important to choose a Chiropractor, Physical Therapist or even a Massage Therapist, skilled in multiple techniques. If you have an injury, a connective tissue condition, or are a Fibromyalgia sufferer, you need to select one that not only looks at the joints but will treat soft-tissue as well.  They also need experience with non-force technique options since flare-ups in patients are common due to weather, changes in stress and body illness.  The following are things to consider when choosing care:

 

  • Does the Doctor use non-force techniques (Activator, Cranio-sacral, Quantum Neurology, Sacral Occiputal Technique)
  • Does the Doctor use a specific technique on soft tissue (Graston, Nimmo, Proprioceptive Neuromuscular Facilitation Stretch, Active Release Technique)
  • Does the Doctor have other patients with this same condition (what are the Doctor’s areas of specialization)?
  • Read reviews!  A Doctor described as “firm” or “rough” is not for you.
  • Optional: Does the Doctor have knowledge of Botanical medicine or Homeopathy for soft tissue disorders?

 

How does a doctor decide how to treat?

Most doctors will take a detailed history of the patient’s condition to determine the most appropriate treatment. Please make sure and tell the Doctor your entire history including any of the following:

 

  • Hereditary connective tissue disease
  • Sensitivity to massage or aggressive pressure (firm hugs)
  • Sensitivity to hot and cold
  • Previous negative chiropractic experience
  • Frequent pain after exercise
  • Tendency to be overly tired
  • Weakness when doing daily activities.
  • All major accidents  (car accidents, broken bones, surgeries, recent falls, etc.)

 

The above information will assist the doctor in determining the correct treatment technique for your needs. Remember, it is possible to cause a flare-up without complete information.  The doctor will then select a technique that will accomplish the following health goals:

 

  • Decreased pain
  • Increased quality of life
  • Re-Injury prevention
  • Decreased flare-ups of condition or old injury
  • Improved body performance in exercise and activities of daily living

 

What can a patient with any of the above conditions do?

It is important to take action to help your body heal and be healthy. Here is a partial list of things you can do. If you have questions, please ask your Doctor to assist you.

 

  • Fish oil
  • Exercise daily:  The rule of thumb is walk or bike at least 15-20 minutes daily as this removes excess inflammation that builds up with injury or disease.
  • Botanical medicine: Malic acid, magnesium and B-vitamins (make sure to ask your Doctor to help with proper dosage and type)
  • Stretching (must be mild to avoid aggravation)
  • Hormone testing if stress is a factor
  • Thyroid testing if hot and cold is a factor
  • Vitamin deficiency testing if fatigue is a factor

 

 

 

 

What makes our Doctors unique when treating the above conditions?

Drs. Ho and Walker are both certified in techniques used to address slow healing soft tissue injuries including:

  • Quantum neurology
  • Sacral Occiput Technique
  • Activator
  • Cranio-sacral
  • Graston
  • Nimmo
  • Procipetive Neuromuscular Facilitation Stretch
  • Active Release Technique

At In-Health Clinic, we provide Chiropractic care as well as botanical medicine and laboratory testing case management. We welcome your questions. If you are not local, we would be happy to assist you in  finding a practitioner in your area.

 

 

Cardiovascular Health

What is the role of the cardiovascular system?

 

The cardiovascular system consists of the heart, blood, and blood vessels (veins, arteries, arterioles and capillaries).  The cardiovascular system is responsible for circulating blood throughout the body providing oxygenation, homeostasis, regulation, protection and waste removal.  Pulmonary circulation carries blood between the heart and lungs while systemic circulation delivers oxygenated blood to the entire body.

 

How does the cardiovascular system work?

 

The heart acts as a pumping system that forces blood into the lungs (pulmonary system) and the body (systemic system) so that oxygen, waste removal and regulation all occur.  The pump forces blood into the lungs and out into the rest of the system. The arteries deliver oxygenated blood to the body as the pump action of the heart forces the blood into the arterioles and capillaries that are located in our extremities.  The veins then return the deoxygenated blood and blood that has picked up waste to the liver and the lungs to be filtered and reoxygenated.

 

What should I know about the heart?

 

The heart is about the size of a clenched fist, weighs about 300g and in most people lies on the left side of the chest.  It is composed of four chambers: the right and left atrium, and right and left ventricles that work together as a pump to distribute blood throughout the body.  The heart beats about 60-80 times per minute. This is often measured in your doctor’s office and is referred to as resting heart rate.   Blood pressure is a measure of the pressure at which the heart pumps as well as the elasticity of the arteries that it is pumped into.  It is essential to have good blood pressure to ensure that your body receives adequate blood supply. It is also important to know that high blood pressure can damage the vessels.

 

What should I know about blood pressure?

 

Blood pressure is measured in a doctor’s office by a sphygmomanometer

which measures both the systolic and diastolic pressure.  The top number is the systolic pressure (a measurement of the blood being pumped from the heart into the blood vessels) and is the highest pressure in the vessels.  The bottom number is the diastolic pressure (a measurement of blood filling the heart between heartbeats) and is the lowest pressure in your vessels.  Medical “normal” blood pressure is 120/80 mmHg, yet most doctors won’t show great concern if your blood pressure is 140/85 unless kidney failure, heart disease and liver failure are a concern.  It is common for the top number to fluctuate. Even going to the doctor’s office can cause an increase in the systolic pressure of about 10 mmHg.   If blood pressure is too low (below 105/65), a person may experience dizziness or fainting. Doctors will also look for at least 30 mmHg between the systolic and diastolic pressure. Less than that is a suggestion that the heart is no longer a strong enough pump.

 

How does cholesterol impact cardiovascular health?

 

The common thought has been that high cholesterol is bad because it causes a build-up of plaque in the blood vessels that impacts the heart’s ability to pump effectively. However, about 50% of patients who suffered a heart attack actually had normal cholesterol levels.  Further research has been done on both HDL (high density lipoprotein) and LDL (low density lipoprotein) which determined it is not the cholesterol but more likely the particle carrier and the density of the lipoprotein sub-types that determine a person’s risk of heart disease.  The National Cholesterol Education Program outlines the following to determine a more accurate cardiovascular risk:

 

  • Small, Dense Ldl: these atherogenic particles are easily oxidized and penetrate the   arterial endothelium to form plaque
  • Lp(A):this small, dense LDL is involved in thrombosis
  • RLP (Remnant Lipoprotein): is very atherogenic, has a similar composition and density of plaque, is believed to be a building block of plaque and does not need to be oxidized like other LDL particles
  • Hdl2B:positively correlates with heart health because it is an indicator of how well excess lipids are removed

 

By performing a Lipoprotein Particle Profile in our office, we can more accurately determine true risk.

 

The last fact about cholesterol to consider is that women in menopause and men in andropause will have an increase in cholesterol due to reduced hormone production while the liver continues to produce the same amount of cholesterol. This can be addressed by balancing hormones.

 

What are the red flags of heart disease that should encourage me to see a doctor?

 

  • Family history of high blood pressure or high cholesterol
  • High body mass index (BMI 30 or greater)
  • Stressful lifestyle
  • Out of breath when walking up stairs or from your car to a grocery store
  • Sweaty and red-faced after activities you used to do without a problem
  • Chest pain
  • Changes in your heart beat
  • Swelling in the legs
  • Low urinary output
  • Constant weakness and fatigue with normal daily activities

 

How can I prevent heart disease?

 

  • Reduce stress.  Change the hours you spend at work, even if you can’t change jobs.  Take vacations and actually rest.  Remove unwanted actives from your schedule and don’t apologize for taking care of yourself.
  • Reduce weight.  If you need to lose 50 pounds or more, consider small changes like portion control long before you actually modify what you eat.  Start exercising gradually. Exercising long and hard right away can actually put strain on a heart that is already under strain.
  • Sleep. Those who regularly sleep six or fewer hours a night are typically heavier than those who regularly sleep more than six hours. Sleep reduces our stress hormones, but it also helps us lose weight and live better.  And guess what?  Those that rested properly scored higher on creativity and productivity tests –something any boss can appreciate.
  • Vegetables.  They are higher in fiber and are packed with more vitamins and nutrients than any other food.  Veggies give you the biggest bang for your buck.
  • Exercise. Besides being a great way to shed a few pounds, exercise also reduces stress, oxygenates blood and removes waste. Walking just 20 minutes a day can lower stress hormones and drastically reduce negative inflammatory waste which is a main culprit of muscle pain.

 

If I’m at risk and showing signs of heart disease is medication my only answer?

 

Depending on your blood work results, angiogram, or EKG, it may be a good time to start working with botanical medicine before you need the more side-effect causing pharmaceuticals. If you are already on medication, botanicals can be supportive enough to allow you to reduce the drug amount or even go off of them completely.  We will always make sure that botanicals do not negatively effect any medications you are on. Common botanical treatment options include:

 

  • Fish oil – high dosage
  • Hawthorn – appropriate dosage
  • Hormone testing and balancing to affect cholesterol or blood pressure
  • Adrenal or stress hormone testing as it plays a large role in heart disease
  • Herbal blend for cholesterol and blood pressure – tested on many patients and shown effective in our office and on our own family members.
  • Blood sugar regulation –pre-diabetic blood sugar levels often contribute to heart disease.

Sports Physicals: Protecting Your Kids Before the Season Starts

As summer winds down, the preparation for school and team sports is heating up!  Before you know it, it will be time to shuttle kids back and forth to practice and games in between school and homework. Back-to-school prep for our young athletes is far more than new shoes, shin guards, athletic bags and water bottles. A Sports Physical should be at the very top of your list!

A PPE (Participation Physical Examination) determines whether it’s safe for your child to play a particular sport and is often required for participation in school or league sports. But even if a PPE isn’t required, it’s still highly recommended.

A Sports Physical consists of collecting a complete medical history as well as a physical exam.

A medical history will include questions about:

  • Family history of serious disease
  • Childhood illnesses such as asthma, diabetes, epilepsy
  • Previous hospitalizations or surgeries
  • Allergies (food, insects, seasonal)
  • Past injuries (broken bones, sprains, concussions)
  • Incidents of chest pain, dizziness, difficulty breathing or fainting
  • Medications, both prescription and over the counter, as well as herbal supplements
  • For female athletes, the regularity and ease of menstrual periods

During the physical portion of the exam, the doctor will:

  • Record height and weight
  • Take a blood pressure and pulse reading
  • Test vision
  • Check the heart and lungs
  • Palpate the abdomen
  • Check ears, nose and throat
  • Evaluate posture, joints, strength and flexibility
  • Make recommendations on how to optimize athletic performance either by seeking treatment or doing specific exercises

A Sports Physical will help diagnose health problems as well as help identify risk factors that are linked to specific sports making for a happier and healthier athletic season!

Call In Health Clinic to schedule your athlete’s Sports Physical.  Ask for our $25 back-to-school special (a $75 value). Onsite appointments are available for schools, teams and groups.

 

Osteoporosis & Men: What You Need to Know

Most people think that osteoporosis is strictly a woman’s health concern. However, more than 2 million men suffer from this condition that causes bones to be brittle and prone to fracture. Men develop osteoporosis about a decade later in life than women, and though men have fewer osteoporosis-related fractures than women (one-third of all hip fractures occurs in men), they are more likely to suffer serious complications or death as a result.

According to the National Osteoporosis Foundation:

  • Up to one in four men over age 50 will break a bone due to osteoporosis.
  • Men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer.
  • Each year, about 80,000 men will break a hip.
  • Men are more likely than women to die within a year after breaking a hip.
  • Men can break bones in the spine or break a hip, but this usually happens at a later age than women.

What puts a man at risk?

In men, wrist fractures have been shown to be an important risk factor for having hip fractures later in life, whereas in women, a previous spine fracture is predictive of subsequent hip fractures. Other risk factors include:

 

  • Family history of osteoporosis
  • Use of steroid medications
  • Unhealthy lifestyle (smoking, alcohol use, lack of exercise)
  • Low testosterone or estrogen levels
  • Prostate cancer and its treatment
  • Immobility due to stroke or heart disease
  • Kidney, lung, gastrointestinal or autoimmune disorders
  • Chronic Disease such as Rhuematoid arthritis, colitis and chron’s disease
  • Medications like Dilantin, Blood thinners and corticosteroids

What should men do to prevent osteoporosis?

For men, maintaining good bone health starts with regular doctor visits to screen for bone mineral density and prostate cancer. Other essentials are:

 

  • Regularly scheduled weight-bearing exercise
  • Healthy, moderate-protein diets
  • Supplements including vitamin D, calcium, magnesium, and isoflavones to help prevent bone mineral losses

Men at risk for hormone-dependent cancers should always discuss supplementation plans with their doctor to ensure that the supplements and medications are working together for best effect.

 

Current Osteoporosis Medications and how they work.

 

Most medications are antiresorptive agents, which decrease the removal of calcium from the bone, it works by suppressing parathyroid hormone which is what takes calcium out of the bone.  Bone is a living dynamic tissue that brings in and takes out calcium and this is where we get calcium if our blood levels or muscle levels are to low.  Extreme athletes may actually harvest calcium from there bone so that their muscles will function more appropriately during extreme events like ultra-marathon’s.

 

The current medications that are in use are:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Raloxifene (Evista)
  • Ibandronate (Boniva)
  • Calcitonin (Calcimar)
  • Zoledronate (Reclast)
  • Denosumab (prolia)

 

Some of the above medications are associated with increases in hip fracture so there are some types of medication doctors will use over others to prevent hip fracture call bisphosphates.  The following are bisphosphates; Fosamax, Actonel, Boniva and reclast.  This doesn’t mean they are completely immune to fracture but are less than other prescriptions.

 

It is still recommended that you do supplementation and lifestyle changes long before you have to seek the help of prescription medications due to side-effects that are present.

 

Eating your Calcium in foods?

 

Many foods we eat contain calcium and milk is one of them, however it is not the most bio-available source and can often pass straight through the system without ever being absorbed into the body itself.  Consider some of these foods instead for adding into your diet:

  • Dates
  • Bean sprouts
  • Beets
  • Bok-choy
  • Spinach, collard greens
  • Black eye peas
  • Quinoa flour, Amaranath flour

Click here to download the Man’s Guide to Osteoporosis from the National Osteoporosis Foundation.

Bursitis

What is bursitis?

Bursitis is caused by inflammation of a bursa, a small fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.  There are approximately 160 bursae in the body.  The major bursae are located bordering the tendons near large joints such as the shoulders, elbows, hips, knees, and ankles. 

What causes bursitis?

Bursitis is most often caused by repetitive minor impact on the area, or a serious injury.  In addition, incorrect posture at work or home and poor stretching or conditioning before exercise can also lead to bursitis. The following risk factors have been associated with the development of bursitis:

  • Repetitive stress or overuse injury
  • Spine disease
  • Joint-related injury
  • Bone spurs or calcium deposits
  • Rheumatoid arthritis
  • Leg-length inequality

Who usually gets bursitis?

Bursitis is more common in adults, especially women over 40 years of age.

What parts of the body does bursitis affect?

Any part of the body that has a bursa can be irritated and inflamed.  However, the following joints have the highest risk factors for the development of bursitis:

  • Shoulder
  • Elbow
  • Hip
  • Knee
  • Achilles tendon

What are the symptoms of bursitis?

The symptoms of bursitis are directly related to the level of inflammation of the bursa.  The inflamed bursa can cause localized pain and tenderness.  If the bursa is so severely inflamed that swelling occurs, it can cause local redness and warmth.  The pain may increase gradually or sudden.  If calcium deposits are present, the pain can be severe. 

How can I prevent bursitis?

Avoiding behaviors and activities that make the inflammation of the bursa worse is the best way to prevent bursitis.  For example:

  • Avoid repetitive activities that put stress on the bursa.
  • Maintain strength and flexibility of the muscle surrounding the joint/bursa.
  • Maintain a healthy weight.

How is bursitis treated?

The doctor will feel the joint for swelling or tenderness.  An x-ray may be taken or fluid from the bursa may be removed with a small needle to check for infection.

Drug therapies include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)  reduce pain and swelling.  Over the counter NSAIDs include: ibuprofen (Motrin, Advil) and naproxen (Aleve). Be forewarned that using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
  • Corticosteroid injections into the bursa can reduce inflammation.  Usually only one shot is needed.  Sometimes oral corticosteroids are used to treat chronic inflammation.

Natural therapies include:

  • A healthy diet including whole grains, fruits, vegetables, and fatty fish and avoiding sugary, fatty and processed foods.
  • Nutraceuticals such as glucosamine sulfate, omega-3 fatty acids, vitamin C with flavonoids and bromelain
  • Herbs such as Boswellia (Boswellia serrata), Turmeric (Curcuma Longa), White Willow (Salic Alba)

The use of nutraceuticals and herbs can decrease the level of inflammation.  However, they can trigger side effects and can interact with other herbs, nutraceuticals, or medications.  They should be taken with care, and under the supervision of a health care provider.

While massage may be tempting to relieve pain, it is not recommended until an infection has been ruled out. Then it may help to reduce the discomfort from a sore joint.

Chiropractic and Movement Therapy

  • Mobilizing the muscles around the joints will help reduce the pressure on the joint and bursa.
  • Graston Therapy may help break down adhesion, increasing flexibility and reducing muscle tension.
  • Other therapies, including chiropractic adjustments and muscle release techniques, may also be helpful to improve muscles and ligaments and reduce the tension caused by repetitive motions.

Research:

Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord. 2007 Nov 5;8:107.

De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; Arthritis Research UK Working Group on Complementary and Alternative Medicines. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford). 2011 May;50(5):911-20. Review.

Huang HH, Qureshi AA, Biundo JJ Jr. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2000 Mar;12(2):150-4. Review.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3-7.

Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. Clin Drug Invest. 2000;19:15-23.

Lewis JS, Sandford FM. Rotator cuff tendinopathy: is there a role for polyunsaturated fatty acids and antioxidants? J Hand Ther. 2009 Jan-Mar;22(1):49-55. Review.

Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust. 2005 Oct 3;183(7):384-8. Review.

Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-256.

Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized, placebo-controlled, double blind clinical trial. Z Rheumatol. 2000;59:314-320.

Vas J, Perea-Milla E, Mendez C, Galante AH, Madrazo F, Medina I, et al. Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]. BMC Complement Altern Med. 2005 Oct 14;5:19.

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